中文摘要：

目的评价肺保护性通气策略对食管癌根治术单肺通气（OLV）老年患者脑组织炎性反应的影响。方法择期行食管癌根治术患者60例，年龄65～80岁，体重45～75 kg，ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为2组（n＝30）：容量控制通气组（VCV组）和容量控制＋肺保护性通气策略组（PV组）。VCV组双肺通气（TLV）期间（VT为10 ml/kg）和OLV期间（VT为7 ml/kg），吸呼比均为1∶2；PV组TLV期间（VT为7 ml/kg）和OLV期间（VT为5 ml/kg），吸呼比均为1∶2，给予呼气末正压5 cmH2O，每45 min肺复张1次；各组均维持PETCO2 35～45 mmHg，BIS值40～60。于诱导前（T1）、TLV 10 min（T2）、OLV 30 min（T3）、再次改为TLV 15 min（T4）和术后24 h（T5）时采集颈静脉球部血样，采用ELISA法测定血清胶质纤维酸性蛋白（GFAP）、TNF-α和IL-6的浓度。于术前（T0）、T5、术后3 d（T6）和术后7 d（T7）时采用简易精神状态检查（MMSE）量表评价认知功能，记录术后谵妄的发生情况。结果与VCV组比较，PV组T3～5时血清TNF-α、IL-6和GFAP浓度降低，T6，7时MMSE评分升高，术后谵妄发生率降低（P〈0.05）。结论肺保护性通气策略降低食管癌根治术OLV老年患者术后脑功能障碍发生的机制与减轻炎性反应有关。

英文摘要：

Objective To evaluate the effect of lung protective ventilation strategy on inflammatory responses in brain tissues of elderly patients requiring one-lung ventilation （OLV） during radical resection for esophagus cancer. Methods Sixty patients of both sexes, aged 65-80 yr, weighing 45-75 kg, of American Society of Anesthesiologists physical status Ⅱor Ⅲ , scheduled for elective radical resection for esophageal cancer, were divided into volume-controlled ventilation （VCV） group （ n = 30） and VCV plus protective ventilation strategy group （PV group, n=30） using a random number table. In group VCV, the tidal volume was set at 10 ml/kg during two-lung ventilation （TLV） and at 7 ml/kg during OLV with inspiratory/expiratory ratio 1 ： 2. In group PV, the tidal volume was set at 7 ml/kg during TLV and at 5 ml/kg during OLV with inspiratory/expiratory ratio 1 ： 2 and positive end-expiratory pressure 5 cmH20, and lung recruitment maneuver was performed every 45 rain. End-tidal pressure of carbon dioxide was maintained at 35-45 mmHg, and bispectral index value at 40-60 in both groups. Before induction of anesthesia （T1 ） , at 10minofTLV （T2）, at 30minofOLV （T3）, at 15 min after restoration of TLV （T4） and at 24halter operation （T5 ） , jugular bulb venous blood samples were taken for determination of serum glial fibrillary acid protein, tumor necrosis factor-α and interleukin-6 concentrations by enzyme-linked immunosorbent assay. The cognitive function was assessed using Mini-Mental State Examination before operation （T0） , at Ts and at 3 and 7 days after operation （T6,7 ）. The occurrence of postoperative delirium was recorded. Results Compared with group VCV, the serum concentrations of tumor necrosis factor-a, interleukin-6 and glial fibrillary acid protein were significantly decreased at T3-5, Mini-Mental State Examination scores were increased at T6,7, and the incidence of postoperative delirium was decreased in group PV （P〈0.05）. Conelusion The mechanism by